Electrocardiography Patterns and the Role of the Electrocardiography Score for Risk Stratification in Acute Pulmonary Embolism

Background and Objectives: Data on the usefulness of a combination of different electrocardiography (ECG) abnormalities in risk stratification of patients with acute pulmonary embolism (PE) are limited. We thus investigated 12-lead ECG patterns in acute PE to evaluate the role of the ECG score in risk stratification of patients with acute PE. Subjects and Methods: One hundred twenty-five consecutive patients (63${\pm}$14 years, 56 men) with acute PE who were admitted to Kyungpook National University Hospital between November 2001 and January 2008 were included. We analyzed ECG patterns and calculated the ECG score in all patients. We evaluated right ventricular systolic pressure (RVSP) (n=75) and RV hypokinesia (n= 80) using echocardiography for risk stratification of acute PE patients. Results: Among several ECG findings, sinus tachycardia and inverted T waves in V$_{1-4}$ (39%) were observed most frequently. The mean ECG score and RVSP were 7.36${\pm}$6.32 and 49${\pm}$21 mmHg, respectively. The ECG score correlated with RVSP (r=0.277, p=0.016). The patients were divided into two groups {high ECG-score group (n=38): ECG score >12 and low ECG-score group (n=87): ECG score ${\leq}$12} based on the ECG score, with the maximum area under the curve. RV hypokinesia was observed more frequently in the high ECG-score group than in the low ECG-score group (p=0.006). Multivariate analysis revealed that a high ECG score was an independent predictor of high RVSP and RV hypokinesia. Conclusion: Sinus tachycardia and inverted T waves in V$_{1-4}$ were commonly observed in acute PE. Moreover, the ECG score is a useful tool in risk stratification of patients with acute PE.